CTC CTC Reimbursement & Billing for Telehealth 2 — Questions and Answers
Question 1: Which CPT code category is most commonly used to bill evaluation and management (E/M) telehealth visits for established patients?
- 99202–99205
- 99211–99215 (Correct answer)
- 99221–99223
- 99241–99245
Correct answer: 99211–99215
CPT codes 99211–99215 are the office or outpatient E/M codes for established patients and are commonly used for telehealth billing.
Question 2: When a patient is located in a federally qualified health center (FQHC) during a telehealth visit, who bills for the originating site facility fee?
- The distant site provider
- The FQHC as the originating site (Correct answer)
- The telehealth platform vendor
- CMS directly to the patient
Correct answer: The FQHC as the originating site
The FQHC acting as the originating site bills for the originating site facility fee using HCPCS code Q3014.
Question 3: What HCPCS code is used to bill the Medicare telehealth originating site facility fee?
- G0463
- Q3014 (Correct answer)
- T1015
- S9083
Correct answer: Q3014
HCPCS code Q3014 is the designated originating site facility fee code for Medicare telehealth services.
Question 4: Under Medicaid telehealth billing, which statement is most accurate?
- All states have identical telehealth reimbursement policies
- States have flexibility to set their own telehealth coverage and reimbursement rules (Correct answer)
- Medicaid never reimburses audio-only telehealth
- Medicaid only reimburses telehealth for pediatric patients
Correct answer: States have flexibility to set their own telehealth coverage and reimbursement rules
Medicaid programs are state-administered, so each state sets its own telehealth coverage policies, eligible providers, and reimbursement rates within federal guidelines.
Question 5: Which documentation element is critical to include in a telehealth visit note to support medical necessity and billing compliance?
- The patient's insurance card scan
- A statement confirming the patient's consent to telehealth and the technology modality used (Correct answer)
- The provider's home address
- A photo of the telehealth device used
Correct answer: A statement confirming the patient's consent to telehealth and the technology modality used
Documenting patient consent and the telehealth modality (audio-video, audio-only) is essential for billing compliance and demonstrating that services were appropriately rendered.
Question 6: Telehealth coordinators reviewing claims denials should first check which factor when a telehealth claim is rejected for 'invalid place of service'?
- The provider's NPI number
- Whether the correct POS code was used and matches payer telehealth policy (Correct answer)
- The patient's date of birth
- The rendering provider's specialty code
Correct answer: Whether the correct POS code was used and matches payer telehealth policy
A POS mismatch is the most common reason for 'invalid place of service' denials; coordinators should verify the correct POS code was applied per the specific payer's telehealth rules.
CTC CTC Reimbursement & Billing for Telehealth 2
Which CPT code category is most commonly used to bill evaluation and management (E/M) telehealth visits for established patients?